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                <div class="f-title">当前位置：<span class="js_index">首页</span> > <span>家庭医生服务</span> > <span>家医签约服务</span></div>
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                        <p class="bg js_my_doctor"><span class="pic icon1201"></span><span class="word">我的家医</span></p>
<p class="js_change_an hide bg"><span class="pic icon1202"></span><span class="word ">建党档案</span></p>
                        <p class="js_change_jy bg"><span class="pic icon1202"></span><span class="word">更换家医</span></p>
                        <p class="js_jy_package bg"><span class="pic icon1203"></span><span class="word">家医服务包</span></p>
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                            <p class="base df "><span>基本服务包</span><span>></span></p>
                            <p class="base df hui js_sel_fu"><span>个性服务包</span><span>></span></p>
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                        <p class="js_suggestion bg"><span class="pic icon1204"></span><span class="word">意见和建议</span></p>
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                            <li>
                                <p class="df first"><span class="circle"></span><span class="tit">1、预约就诊：</span></p>
                                <p class="second bb">为签约居民提供专人管理、专人诊疗预约时间随到随诊，避免等候</p>
                            </li>
                            <li>
                                <p class="df first"><span class="circle"></span><span class="tit">2、预约转诊：</span></p>
                                <p class="second bb">全科医生解决不了的疑难问题，直接转诊至大医院相关专家大医院开辟社区转诊专用窗口</p>
                            </li>
                            <li>
                                <p class="df first"><span class="circle"></span><span class="tit">1、预约就诊：</span></p>
                                <p class="second bb">为签约居民提供专人管理、专人诊疗预约时间随到随诊，避免等候</p>
                            </li>
                            <li>
                                <p class="df first"><span class="circle"></span><span class="tit">1、预约就诊：</span></p>
                                <p class="second bb">为签约居民提供专人管理、专人诊疗预约时间随到随诊，避免等候</p>
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                        <div class="tit bb">您还未在广内社区卫生服务中心建档，请如实填写以下信息建档信息</div>
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                        <div class="write bb cs">
                            <p class="tits df"><span class="icon"></span><span>基本情况</span></p>
                            <div class="w-con df bb">
                                <div class="w-left bb w">
                                    <p class="row bb df"><span class="t">姓名:</span><input type="text" class="bb"
                                            placeholder="请输入您的真实姓名"></p>
                                    <p class="row bb df"><span class="t">出生日期:</span><input type="text" class="bb"
                                            placeholder="2018-01-31"></p>
                                    <p class="row bb df"><span class="t">籍贯:</span><input type="text" class="bb"
                                            placeholder="请输入您的籍贯"></p>
                                    <p class="row bb df"><span class="t">婚姻状况:</span><span class="circle bb yi"><i></i></span><span
                                            class="word">未婚</span> <span class="circle bb er cb"><i class="cg"></i></span><span
                                            class="word">已婚</span></p>
                                    <p class="row bb df"><span class="t">工作单位：</span><input type="text" class="bb"
                                            placeholder="请输入您的工作单位"></p>
                                    <p class="row bb df"><span class="t">职业：</span><input type="text" class="bb"
                                            placeholder="请输入您所从事的职业"></p>
                                    <p class="row bb df"><span class="t">单位电话：</span><input type="text" class="bb"
                                            placeholder="请输入您单位电话"></p>
                                    <div class="block bb">
                                        <p class="row bb df rows"><span class="t">现住址：</span><input type="text" class="bb"
                                                placeholder="请输入现在居住的详细地址"></p>
                                        <p class="row bb df rows"><span class="t">邮政编码：</span><input type="text" class="bb"
                                                placeholder="请输入邮政编码"></p>
                                        <p class="row bb df rows"><span class="t">所属派出所：</span><input type="text" class="bb"
                                                placeholder="请输入派出所名称"></p>
                                        <p class="row bb df rows"><span class="t">所属居委会：</span><input type="text" class="bb"
                                                placeholder="请输入所属居委会"></p>
                                        <p class="row bb df rows"><span class="t">住宅电话：</span><input type="text" class="bb"
                                                placeholder="请输入住宅电话"></p>
                                        <p class="row bb df rows"><span class="t">本人手机：</span><input type="text" class="bb"
                                                placeholder="请输入自己手机号"></p>
                                        <p class="row bb df rows"><span class="t">联系人姓名：</span><input type="text" class="bb"
                                                placeholder="请输入紧急联系人姓名"></p>
                                        <p class="row bb df rows"><span class="t">联系人电话：</span><input type="text" class="bb"
                                                placeholder="请输入紧急联系人电话"></p>
                                    </div>
                                    <div class="block bb">
                                        <p class="row bb df rows"><span class="t">定点医疗单位</span></p>
                                        <p class="row bb df rows"><input type="text" class="bb" placeholder="请输入您的医疗单位"><span
                                                class="add t">+</span></p>
                                    </div>
                                </div>
                                <div class="w-right bb w">
                                    <p class="row bb df"><span class="t">性别:</span><span class="circle bb yi"><i></i></span><span
                                            class="word">男</span> <span class="circle bb er cb"><i class="cg"></i></span><span
                                            class="word">女</span></p>
                                    <p class="row bb df"><span class="t">身份证号:</span><input type="text" class="bb"
                                            placeholder="请输入您的身份证号"></p>
                                    <p class="row bb df"><span class="t">民族:</span><input type="text" class="bb"
                                            placeholder="请输入您的民族"></p>
                                    <p class="row bb df"><span class="t">文化程度：</span><input type="text" class="bb"
                                            placeholder="请输入您的学历"></p>
                                    <p class="row bb df"><span class="t">常住类型：</span><span class="circle bb yi"><i></i></span><span
                                            class="word">户籍</span> <span class="circle bb er cb"><i class="cg"></i></span><span
                                            class="word">非户籍</span></p>
                                    <div class="row bb df">
                                        <p class="l t">血型：</p>
                                        <div class="s">
                                            <p class="bb df borderb">
                                                <span class="circle bb "><i></i></span><span class="word">A型</span>
                                                <span class="circle bb san cb"><i class="cg"></i></span><span class="word">B型</span>
                                                <span class="circle bb san cb"><i class="cg"></i></span><span class="word">O型</span>
                                                <span class="circle bb san cb"><i class="cg"></i></span><span class="word">AB型</span>
                                                <span class="circle bb san cb"><i class="cg"></i></span><span class="word">不详</span>
                                            </p>
                                            <p class="bb df">
                                                <span class="circle bb  cb"><i class="cg"></i></span><span class="word">RH：阴性</span>
                                                <span class="circle bb si cb"><i class="cg"></i></span><span class="word">RH：阳性</span>
                                                <span class="circle bb wu cb"><i class="cg"></i></span><span class="word">不详</span>
                                            </p>
                                        </div>
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                                    <div class="block bb">
                                        <p class="row bb df rows radius"><span class="t">医疗费用支付方式</span></p>
                                        <div class="checks bb">
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">城镇职工基本医疗保险</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">城镇居民基本医疗保险</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">新型农村合作医疗</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">贫困救助商业医疗保险</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">全公费</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">全自费</span> </p>
                                            <p class="row bb df rows c"><input type="checkbox" class="bb check"><span
                                                    class="t">其他</span> </p>
                                        </div>
                                    </div>
                                    <div class="block bb">
                                        <p class="row bb df rows"><span class="t">医保号：</span><input type="text" class="bb"
                                                placeholder="请输入您的医保账号"></p>

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